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Martin McKee on the Manifesto for Planetary Health

By rob hopkins 27th May 2014

One of the most fascinating things I read recently was The Lancet’s Manifesto for Planetary Health(printed in full at the end of this post). For one of the most august and respected medical journals to argue that “the idea of unconstrained progress is a dangerous human illusion”, to call for “a new vision of cooperative and democratic action at all levels of society” and to state that “our patterns of overconsumption are unsustainable and will ultimately cause the collapse of our civilisation” is remarkable, and timely. Here’s a short video in which The Lancet’s editor, Richard Horton, explains more about the Manifesto:

We talked to Martin McKee, Professor of Public Health at the London School of Hygiene and Tropical Medicine, and one of the report’s authors.

Reading around in other things about the manifesto, there’s a term that comes up that I’d not come across before, which was “social medicine”. What’s social medicine?

Social medicine is a term that actually goes back to at least the 1920s and the 1930s. In more recent years it’s been termed public health. This is essentially the idea that we should be looking at the health of populations and in particular that governments have a role to play in promoting health. Quite simply put, there is such a thing as society and individuals do need the support to make healthy choices. As has been said before, we all do make choices but not always in the circumstances of our own choosing.

Is the Manifesto arguing that capitalism is bad for our health?

If you look back historically, back to the late 1980s, we saw that one of the alternatives, communism, clearly was very bad for people’s health. Life expectancy was stagnating under the communist regimes and I think there is now really no doubt that the model of communism that had been implemented in the Soviet Union and in the countries of Eastern Europe had failed and was rejected by the population.

If we look at the model of capitalism – and I stress I’m not talking about either of these in their totality – but if we look at the particular model of capitalism we have at the moment and we look at the way in which it brought about the economic crisis with essentially as Adair Turner said, the global stock markets serving “no socially useful purpose”, we can see that that particular model has failed. Failed in terms of delivering benefits to the wider population. The US and the UK have seen virtually no increase in median earnings over the last three decades, so it’s certainly not working in terms of the economy.

There’s no doubt that both the communist system that was in place before 1990 and the capitalist system that led to the economic crisis have both failed abysmally and we need a new way of doing things. Is the capitalist system that we have at the moment bad for our health? Well clearly it is because we’re seeing a vastly more unequal society. People are not sharing equally in the game. The French economist Thomas Picketty has written a damning critique of the system as it is, showing that things are going to get worse.

So although I’m not talking about capitalism in its totality I would refer back to the work of people like Adam Smith, he of “the invisible hand of the market”. He balanced his call for markets in his second book A Theory of Moral Sentiment recognising that free markets have many problems. The capitalist system has potentially within it the seeds of its own destruction unless it can balance whatever its dong with some socially useful purpose.

In the Manifesto, you write at the end ‘together with empowered communities we can confront entrenched interests and forces that jeopardise our future.’ Is there a case, do you think, that Transition groups and such initiatives could actually gain more profile and by arguing what they do not just in terms of sustainability but in terms of public health?

Yes, I think so. The very heart of what we’re advocating is the idea that the two are linked. We cannot have a healthy population without a healthy planet, but the difficulty is that one of course needs to frame one’s argument differently for different audiences. In the past, the public health community has very much focused discussions on the way better health is better for the economy. But we also have to realise that we need to square that circle to some extent.

I was very interested in the bit about ‘the idea of unconstrained progress is a dangerous human illusion.’ With people like Matt Ridley’s book about The Rational Optimist and James Delingpole writing this week about how young people today have never had it so good and they should stop moaning and just be aware that they live at the pinnacle of civilisation. That’s a really dangerous and complacent perspective isn’t it?

It also ignores the basic laws of physics. And we go back to the issue of entropy. Whenever the earth was formed, without getting too much into geological timescales, all sorts of things were distributed in ways that were easily extractable, rare earths and petroleum in the Carboniferous period, the vegetable matter that lead to the development of oil and gas and so on. Obviously, if we take, we redistribute all of these things or use them up from the settings in which they’re constructed. We’re not going to be able to use them twice, and inevitably we’ll run out of things.

An urgent transformation is required in our values and our practices based on recognition of our interdependence and the interconnectedness of the risks we face. We need a new vision of cooperative and democratic action at all levels of society and a new principle of planetism and wellbeing for every person on this Earth – a principle that asserts that we must conserve, sustain, and make resilient the planetary and human systems on which health depends by giving priority to the wellbeing of all. All too often governments make commitments but fail to act on them; independent accountability is essential to ensure the monitoring and review of these commitments, together with the appropriate remedial action.

It’s not just running out of oil. It’s running out of some of the things that we depend on, like tantalum in mobile phones or iridium in GPS devices and things like that. Some of the rare earths that we use, neodymium and lanthanide in some of the low energy hybrid cars and things like that.

Fundamentally we will end up taking the things from fairly concentrated deposits in the earth’s crust and depositing them into land sites all over the world and not be able to have any economically viable way of extracting them again. That’s just an inevitability.

Jared Diamond has written a very good book called Collapse. He describes how so often in the past very well-developed civilisations going back to the Indus valley and onwards have actually presided over their own fundamental collapse as they’ve brought about environmental degradation. It’s nice that people are optimistic but it defies the laws of physics and it also defies the historical experience.

The Manifesto for Public Health

This manifesto for transforming public health calls for a social movement to support collective public health action at all levels of society – personal, community, national, regional, global, and planetary. Our aim is to respond to the threats we face: threats to human health and wellbeing, threats to the sustainability of our civilisation, and threats to the natural and human-made systems that support us. Our vision is for a planet that nourishes and sustains the diversity of life with which we co-exist and on which we depend. Our goal is to create a movement for planetary health.

Our audience includes health professionals and public health practitioners, politicians and policy makers, international civil servants working across the UN and in development agencies, and academics working on behalf of communities. Above all, our audience includes every person who has an interest in their own health, in the health of their fellow human beings, and in the health of future generations.

The discipline of public health is critical to this vision because of its values of social justice and fairness for all, and its focus on the collective actions of interdependent and empowered peoples and their communities. Our objectives are to protect and promote health and wellbeing, to prevent disease and disability, to eliminate conditions that harm health and wellbeing, and to foster resilience and adaptation. In achieving these objectives, our actions must respond to the fragility of our planet and our obligation to safeguard the physical and human environments within which we exist

Planetary health is an attitude towards life and a philosophy for living. It emphasises people, not diseases, and equity, not the creation of unjust societies. We seek to minimise differences in health according to wealth, education, gender, and place. We support knowledge as one source of social transformation, and the right to realise, progressively, the highest attainable levels of health and wellbeing.

Our patterns of overconsumption are unsustainable and will ultimately cause the collapse of our civilisation. The harms we continue to inflict on our planetary systems are a threat to our very existence as a species. The gains made in health and wellbeing over recent centuries, including through public health actions, are not irreversible; they can easily be lost, a lesson we have failed to learn from previous civilisations. We have created an unjust global economic system that favours a small, wealthy elite over the many who have so little.

The idea of unconstrained progress is a dangerous human illusion: success brings new and potentially even more dangerous threats. Our tolerance of neoliberalism and transnational forces dedicated to ends far removed from the needs of the vast majority of people, and especially the most deprived and vulnerable, is only deepening the crisis we face. We live in a world where the trust between us, our institutions, and our leaders, is falling to levels incompatible with peaceful and just societies, thus contributing to widespread disillusionment with democracy and the political process.

An urgent transformation is required in our values and our practices based on recognition of our interdependence and the interconnectedness of the risks we face. We need a new vision of cooperative and democratic action at all levels of society and a new principle of planetism and wellbeing for every person on this Earth – a principle that asserts that we must conserve, sustain, and make resilient the planetary and human systems on which health depends by giving priority to the wellbeing of all. All too often governments make commitments but fail to act on them; independent accountability is essential to ensure the monitoring and review of these commitments, together with the appropriate remedial action.

The voice of public health and medicine as the independent conscience of planetary health has a special part to play in achieving this vision. Together with empowered communities, we can confront entrenched interests and forces that jeopardise our future. A powerful social movement based on collective action at every level of society will deliver planetary health and, at the same time, support sustainable human development.